There are currently three major types of mechanical stapling devices in clinical use for open and laparoscopic surgery. As described in Tables 1 and 2, the principles and prerequisites of mechanical stapling remain largely unchanged.
Tablel. Principles of mechanical stapling
Tissue stapling using metallic wire as staples Configuration of the closed staples in B-shape Staggered positioning of the staple lines
Table2. Aims of surgical stapling
Creation of an adequate lumen
Preserving adequate tissue vascularization
Preventing tension of adapting tissues
Avoiding leakage and fistula formation
Provision of good hemostasis
Mechanical reliability/uniformity of stapling devices
Linear staplers are predominantly used to close the ends of a hollow organ or vessel. They are claimed to give easier access to narrow anatomic sites such as the pelvis. For such applications, linear staplers with articulated heads and flexible shafts have been developed. These staplers normally apply two lines of staples that are staggered to maximize local blood supply. Vascular linear staplers apply three staggered lines of staples to achieve tight closure of the vessel. The staple height is either fixed or, with some brands of stapler, can be "adjusted" during the application. For most applications, the use of a fixed staple height is preferred. Because linear staplers are mainly used to close open organs, they do not include a cutting device.
The length of the stapler lines varies between 30 mm and 90 mm, while the height of individual staples varies from 2.5 mm to 4.8 mm, depending on the tissue to be stapled (e.g., vascular staples = 2.5 mm; staples for normal intestinal tissue = 3.5 mm; for stomach or thicker tissues = 4.8 mm).
Linear Cutter or GIA Stapler (Gastrointestinal Anastomosis Stapler, A)
These staplers are basically linear staplers with an integrated cutting device. Four staggered lines of staples (two "rows") are applied, and the tissue between the two inner staple lines is transected. The main indications are transecting and stapling closed both ends of a hollow organ (e.g., bowel, bronchus) or vascular structure. In addition, because of the two separate rows of staples, side-to-side anastomoses can be created. The staple height is fixed and must be chosen before using the instrument in accordance to the type of tissue. Different staple sizes and wire diameters are available in preloaded, single-use cartridges.
The length of the staple lines varies between 55 mm and 100 mm for open surgery.
Specially designed linear cutters have been developed for minimally invasive surgery (B). Articulated heads are often used to overcome angulations related to the trocar positioning.
These staplers apply two staggered circular lines (one "row") of staples. The cutting device transects the tissue inside the staple lines. The staple height is also variable, depending on the tissue thickness. Circular staplers are used mainly for end-to-end and end-to-side anastomoses of the esophagus, stomach, and rectum.
Circular staplers are available with various diameters, ranging from 21mm to 33 mm. It should be noted that the true (inner) diameter of the created anastomosis is somewhat smaller (range 12.4-24.4mm). In order to avoid mucosal tears, sizers should be used to estimate the diameter of the respective hollow organ. The anvil must be secured by a proper purse-string suture which is applied intraluminally to create the anastomosis.
Was this article helpful?
For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.